RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03220
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20011005

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Rifleman, medically separated for “plantar fasciitis bilaterally,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  The CI’s condition worsened.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20010907	VARD - 20020820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Plantar Fasciitis Bilaterally	5399-5310	20%	Plantar Fasciitis, Pes Planus Bilaterally	5299-5278	10%	20011125	
Pes Planus Bilaterally 	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Plantar Fasciitis Bilaterally.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot pain condition began in June 2008 with no related history of trauma.  Pes Planus (flatfeet) was noted on the MEPS physical examination prior to accession.  The CI reported a 2-month history of heel pain following Airborne School when first seen on 4 May 2000.  He was treated with custom orthotics, physical therapy, medications, and duty modifications.  Despite treatment, he could not meet full duty requirements and was referred for an MEB.  A podiatry note, dated 19 July 2000, recorded his “physical exam is totally inconsistent with verbal complaints.”  At the MEB NARSUM examination, on 27 July 2001, 3 months prior to separation, it was noted that the CI had reported on 12 July 2001, he was unable perform his duties because “his foot pain was so bad.”  The physical examination showed there was tenderness over the entire plantar aspect of the foot bilaterally.  There was no redness, swelling, or bruising.  On weight bearing (standing), the ankles were noted to roll in, the arch disappeared (flat feet), and the heels were in valgus (ankles rolled inward over the heels).  Movement of the feet (toes up) elicited pain over the plantar fascia.  He was thought to have bilateral plantar fasciitis and pes planus.  

At the VA Compensation and Pension (C&P) examination, performed on 21 November 2001, 7 weeks after separation, the CI reported his feet bothered him after prolonged standing or walking.  On examination, he had flat feet bilaterally with essentially full range of motion of the ankles.  He was able to walk briskly down the hallway without an assistive device.  He could dress and undress without difficulty.  No varus or valgus (ankles in or out) was present and the examination of the feet was unremarkable without tenderness, swelling, or deformity.  He was thought to have bilateral pes planus, but was not diagnosed with plantar fasciitis.  At the general C&P, 4 days later, he was noted to have a “steady gait” (normal).  There are no further records in evidence indicating treatment for the feet until a VA urgent care note, dated 15 December 2003, over 2 years after separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a combined 20% rating, 10% for each foot at a moderate level of impairment, under an analogous 5399-5310 code (Group X muscles: movements of forefoot and toes), citing pain when feet were dorsiflexed and tension brought to bear on the plantar fascia.  The pes planus condition was noted to be Category II, contributing to the unfitting condition, but not separately unfitting.  The VA assigned a 10% rating for both feet using an analogous 5299-5278 code, (claw foot), based on the VA C&P examination a month after separation, citing limitation of dorsiflexion at the ankle and tenderness under the metatarsal heads.  It subsequently rated each foot 10% effective 9 August 2006, almost 5 years after separation.  

The Board noted that the CI had normal or near normal examinations proximate to separation other than the pes planus.  His gait was brisk on one examination and “steady” on another within weeks of separation.  The primary impairment, pain, cannot be assigned to both the bilateral plantar fasciitis condition and the bilateral pes planus condition without violation of VASRD §4.14 (avoidance of pyramiding).  The Board found no route to a rating higher than the combined 20% rating adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral plantar fasciitis condition.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition and IAW VASRD §4.71a and 4.73, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140514, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 10 Jun 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC